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This document is used to refer individuals seeking assistance with smoking cessation, including information about their demographics, smoking habits, and interest in support programs.

How to fill out smoking cessation referral

How to fill out Smoking Cessation Referral

1. Obtain the Smoking Cessation Referral form from the healthcare provider's office or website.
2. Fill out patient information, including full name, date of birth, and contact details.
3. Provide relevant medical history, including any previous attempts to quit smoking and current smoking status.
4. Indicate the patient's motivation to quit and any support systems in place.
5. Include healthcare provider information, such as name, contact details, and signature.
6. Review the completed form for accuracy and ensure all required fields are filled.
7. Submit the referral form to the appropriate smoking cessation program or specialist.

Who needs Smoking Cessation Referral?

1. Individuals who are current smokers looking to quit.
2. Patients with smoking-related health issues.
3. People who have previously tried to quit without success.
4. Individuals seeking structured support and guidance in their cessation efforts.

People Also Ask about

How do you refer to smoking cessation?

How to contact a stop smoking adviser. Your GP, pharmacist or health visitor can refer you, or you can phone your local stop smoking service to make an appointment with an adviser.

What is the ICD-10 code for smoking cessation counseling?

Documentation Requirements Elements of documentation for CPT codes 99406-99407 may include, but are not limited to: • Type or method of tobacco use (cigarettes, pipe, chewing tobacco, etc.) Impact (personal, family, friends, health, social, financial, etc.)

What documentation is required for 99406?

When counseling your patients about smoking, the Agency for Healthcare Research recommends a brief smoking cessation intervention known as the "5 A's": Ask, Advise, Assess, Assist, and Arrange. This entire counseling process takes less than three minutes.

How do I document smoking cessation counseling?

In addition to the amount of time spent counseling the patient, other elements to be documented to support medical necessity of the service include: Verification of the patient's history of tobacco use. Assessed willingness to attempt to quit. Was a quit date set?

How to bill for tobacco cessation counseling?

ICD-10 code Z71. 6 for Tobacco abuse counseling is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .

For pdfFiller’s FAQs

What is Smoking Cessation Referral?

Smoking Cessation Referral is a process where healthcare providers refer individuals who smoke to programs or services designed to help them quit smoking.

Who is required to file Smoking Cessation Referral?

Healthcare professionals, such as doctors, nurses, and counselors, are typically required to file Smoking Cessation Referrals for patients who smoke and express a desire to quit.

How to fill out Smoking Cessation Referral?

To fill out a Smoking Cessation Referral, providers should complete the referral form with patient information, smoking history, any previous cessation attempts, and the recommended cessation program details.

What is the purpose of Smoking Cessation Referral?

The purpose of Smoking Cessation Referral is to connect individuals with appropriate resources and support to help them quit smoking, thereby improving their health and reducing smoking-related illnesses.

What information must be reported on Smoking Cessation Referral?

The information that must be reported on a Smoking Cessation Referral includes patient demographics, smoking status, cessation history, current health conditions, and preferred treatment options or programs.